Changes in medical end-of-life practices during the legalization process of euthanasia in Belgium

Changes in medical practices during transitions in regulating healthcare are rarely investigated. In this study, we investigated changes in medical end-of-life decisions with a possible or certain life-shortening effect (ELDs) that occurred during the legalization process of euthanasia in Belgium. We took representative random samples from deaths reported to registries in Flanders, Belgium in 1998 (n=3999) at the beginning of the process and in 2001 (N=5005), at the end of the process. The reporting physicians received an anonymous mail questionnaire about possible ELDs preceding the death involved. We found no significant shifts in the epidemiology of diseases between 1998 and 2001. The overall incidence of ELDs did not change. The incidence decreased for euthanasia, administering life-ending drugs without patient's explicit request, and alleviation of pain and symptoms with life-shortening co-intention. Incidence increased for alleviation of pain and symptom without life-shortening intention, and remained stable for non-treatment decisions. All decisions in 2001 were more often discussed with patients, their relatives and nurses. In 2001, continuous deep sedation was reported in 8.3% of deaths. We can conclude that physicians' end-of-life practices have substantially changed during the short but tumultuous legalization process of euthanasia in Belgium. Although follow-up research is needed to investigate the continuance of these changes, it is important for policy makers to keep in mind that social factors related to transitions in healthcare regulation may play an important role in the physicians' actual behaviour.     

Socio-economic inequalities in health expectancy in Belgium

Various international studies have demonstrated socio-economic differences in health. Linking the 1991 Census to the National Register and using the Health Interview Survey 1997 has enabled assessment of the association between the level of education and health in Belgium using the composite indicator 'health expectancy'. The Sullivan method was used to calculate health expectancy on the basis of current probability of death and prevalence of perceived health. Two measures of educational attainment were used: absolute educational attainment and the position on a relative hierarchical educational scale obtained by a regression-based method. The latter measure enables international comparisons. Differences in health expectancy by education were spread over the whole range of the educational hierarchy, and were consistently larger among females than males. At 25 years of age, the difference in health expectancy between different levels of education reached up to 17.8 and 24.7 years in males and females, respectively. Compared with people with the highest educational attainment, males and females at the lowest level of education spent more than 10 and 20 additional years in poor perceived health, respectively. Between ages 25 and 75 years, the difference in health expectancy between people with the lowest and highest levels of education was 17 years among males and 21 years among females. Compared with people at the top of the relative educational scale, males and females at the bottom of the scale had 13.6 and 19.7 additional years in poor perceived health, respectively. The conclusions of this study in Belgium are consistent with studies in other countries. People with a low level of education have shorter lives than people with a higher level of education. They also have fewer years in good perceived health, and can expect more years in poor health in their shorter lives. The inequality in health expectancy seems to be greater in females than males.     

Income-related health inequality in Belgium: a longitudinal perspective

This paper provides new evidence on the degree of income-related inequality in self-assessed health in Belgium. First of all, we combine the time dimension, which has been shown to be very important in the analysis of inequality, and the use of the recently developed interval regression approach to transform a categorical health variable in a continuous one. Second, we measure how the long-run inequality differs from the short-run inequality. Finally, we decompose this health-related income mobility index as well as the long-run concentration index (CI) itself into its contributors. Using data from the panel survey of Belgian households (1994–2002), we find that health is pro-rich distributed and that its inequality is underestimated by 9.45% when neglecting the dynamics of individuals over time. Income, education, job status and age are the most important contributors in the CI and the difference between the short-run and long-run inequality.      

中国农村营养改善计划地区2019年学生零食消费及影响因素

目的 分析中国中西部贫困农村中小学生的零食消费情况及影响因素,为正确引导儿童合理消费零食、促进健康成长提供基础数据。 方法 2019年,在实施“农村义务教育学生营养改善计划”的中西部22个省699个县中,分片选取1~3个国家试点县,共选取50个重点监测县。按照不同供餐模式,随机各抽取2所小学和2所初中作为重点监测学校。从小学三年级到初中三年级,每个年级抽取1~2个班。采用学生调查表收集所调查的27 374名学生的零食消费频率、花费和种类等信息。 结果 中国中西部贫困农村有14.0%的学生每天吃零食≥2次,21.6%的学生每天零食花费≥3元。零食选择的前3位依次是蔬菜、水果(50.6%),饼干、面包(50.1%),膨化食品(40.0%)。多因素Logistic回归分析显示,母亲在外地打工、父母都在外地打工、企业供餐、校园里有小卖部或超市的学生每天摄入≥1次零食的可能性更高(OR值分别为1.35,1.19,1.11,1.51,P值均 < 0.05)。 结论 中国中西部贫困农村中小学生零食消费现象较为普遍,且存在零食选择不合理的问题。应建立个人、家庭、学校、社会全方位支持引导的健康教育体系,引导学生合理选择零食。     

普陀区小学生零食消费行为分析

目的了解小学生零食消费现状,为学生营养干预工作提供基础资料。方法随机整群抽取普陀区2所公办小学二至四年级1 023名学生作为调查对象,进行零食消费行为问卷调查。结果小学生零食指南扇面图的知晓率仅为13.9%,摄入的零食有66.9%来自于家庭。学生平均每天吃零食3.75次,有49.6%的学生每天摄入零食3次及以上。新鲜蔬菜水果、奶及奶制品在零食摄入中位居前2位。谷类适量类、饮料类适量类、肉蛋海产品适量类分别位居第3～5位。薯类可经常食用类是后5位顺位零食之一。结论普陀区小学生零食摄入不合理。需要通过营养干预帮助他们科学、合理地消费零食,促进健康成长。     

Ethics policies on euthanasia in nursing homes: a survey in Flanders, Belgium

In many European countries there is a public debate about the acceptability and regulation of euthanasia. In 2002, Belgium became the second country after the Netherlands to enact a law on euthanasia. Although euthanasia rarely occurs, the complexity of the clinical-ethical decision making surrounding euthanasia requests and the need for adequate support reported by caregivers, means that healthcare institutions increasingly need to consider how to responsibly handle euthanasia requests. The development of written ethics policies on euthanasia may be important to guarantee and maintain the quality of care for patients requesting euthanasia. The aim of this study was to determine the prevalence, development, position, and communication of written ethics policies on euthanasia in Flemish nursing homes. Data were obtained through a cross-sectional mail survey of general directors of all Catholic nursing homes in Flanders, Belgium. Of the 737 nursing homes invited to participate, 612 (83%) completed the questionnaire. Of these, only 15% had a written ethics policy on euthanasia. Presence of an ethics committee and membership of an umbrella organization were independent predictors of whether a nursing home had such a written ethics policy. The Act on Euthanasia and euthanasia guidelines advanced by professional organizations were the most frequent reasons (76% and 56%, respectively) and reference sources (92% and 64%, respectively) for developing ethics policies on euthanasia. Development of ethics policies occurred within a multidisciplinary context. In general, Flemish nursing homes applied the Act on Euthanasia restrictively by introducing palliative procedures in addition to legal due care criteria. The policy was communicated to the consulting general practitioner and nurses in 74% and 89% of nursing homes, respectively. Although the overall prevalence of ethics policies on euthanasia was low in Flemish nursing homes, institution administrators displayed growing awareness of bearing responsibility for stimulating dialogue and reflection about how to deal with euthanasia requests within their institution.     

Increasing Incidence of Mucormycosis in University Hospital, Belgium

To determine why incidence of mucormycosis infections was increasing in a large university hospital in Belgium, we examined case data from 2000–2009. We found the increase was not related to voriconazole use but most probably to an increase in high-risk patients, particularly those with underlying hematologic malignancies.     

综合性医院171例医院感染病例临床分析

目的 了解医院住院患者医院感染发病状况和影响因素,以便加强对重点科室感染动态监测,预测医院感染发生.方法 监测医院2008年1～12月出院患者病历12 543份,对所发生的医院感染171例病例进行前瞻性和回顾性调查分析.结果 2008年医院感染率为1.4%,其中外一科和儿科是医院感染的高发科室,感染率分别为2.8%和2.4%;感染高发部位为呼吸道,其次为手术切口感染,大肠埃希菌已成为医院感染手术切口感染的主要致病菌.结论 加强医护人员医院感染管理知识的培训,严格执行无菌技术操作,减少不必要的侵入性操作,儿科和普外科要作为重点监控科室,合理使用抗菌药物,及时、准确做好病原菌监测,是降低医院感染的有效措施.     

Seat belt use and social inequality in Belgium

BACKGROUND: To search for and quantify the importance of socio-economic inequality in seat belt use in young Belgians (15-24 years old). METHODS: Using the data of the National Health Survey of Belgium (1997), socio-economic indicators were constructed combining characteristics of the individual and the household to which s/he 'belongs' (equivalent household income, employment, poverty, subjective poverty, and socio-economic insecurity) and the corresponding concentration curves and indices were calculated. RESULTS: Significant differences were found in seat belt use related to young people's socio-economic status. The failure to buckle up was concentrated most heavily in the least favoured socio-economic groups. Such inequality was a constant finding, although its magnitude varied according to the socio-economic indicator used, going from -0.142 for the variable 'occupational category of the household' to -0.028 for the variable 'poverty'. CONCLUSIONS: This finding of true socio-economic inequality in the use of seat belts by 15-24 year olds should prompt special vigilance in health promotion approaches aimed at changing behaviour. It also underlines the importance of being attentive to the socio-economic indicators that are chosen to quantify such inequality in intra- and inter-country comparisons.     

Work accident victims: a comparison between non-standard and standard workers in Belgium

Background: The fast growth of non-standard employment in developed countries highlights the importance of studying the influence of contract type on worker’s safety and health.

Objective: The main purpose of our study is to investigate whether non-standard workers are more injured than standard workers or not. Additionally, other risk factors for occupational accidents are investigated.

Methods: Data from the Belgian surveys on work ability in 2009 and 2011 are used. During their annual occupational health examination, workers were asked to fill in a self-administered questionnaire. In total, 1886 complete responses are collected and analyzed using logistic regression.

Results: Temporary workers did not have higher injury rates than permanent workers [OR 0.5, 95% confidence interval 0.2–1.2]. Low-educated, less-experienced workers and those exposed to dangerous conditions are more frequent victims of occupational accidents.

Conclusion: The present data do not support the hypothesis that non-standard workers have more injuries than standard workers. Our results about occupational accidents derived from a non-representative sample of the Belgian workforce and cannot be generalized due to the heterogeneity in job organization and labor regulations between countries. Further research is needed to extend our findings and to seek other factors that may be associated with work accidents.     

Premature avoidable deaths by road traffic injuries in Belgium: trends and geographical disparities

Road traffic injuries are a major public health problem. In this study, we chose Years of Potential Life Lost (YPLL) to analyse the trends during the period 1974–1994 and the relative impact of the traffic injuries death on total mortality and on total avoidable mortality in Belgium. We analysed the geographical trends over a 20-year period at the district level. The YPLL age-adjusted rates were analysed for four successive 5-year periods: 1974–1978, 1980–1984, 1985–1989, 1990–1994 and the ratios of YPLL rates were used to describe changes between 1974 and 1994 at district level. The YPLL rates decrease for all causes mortality, total avoidable causes and road traffic injuries. This trend can be observed during the four periods of 5 years. A slowing down of the decrease of the YPLL rates for road traffic injuries, both for men and women is observed: 11.7% between periods 2 and 1, and only 3% between periods 4 and 3 for men (16.2 and 7.5% for women). The geographical analysis shows marked differences between districts. Even though a favourable trend is observed for the traffic injuries deaths in Belgium it is important to highlight the important slowing down of this trend during the most recent years. It is also necessary to underline the importance of geographical disparities in the distribution of YPLL rates within the entire population.     

Neighbourhood migrant composition and tobacco-related cancer mortality: A census-linked study among five origin groups in urban Belgium

We studied the role of ‘ethnic density’ in the neighbourhood for tobacco-related cancer mortality among five migrant origin groups in urban Belgium. Using full population linked census data, multilevel Poisson models were applied to model effects of three linear and categorical indicators of same-origin presence for each origin group, and to test effect mediation by migrant generation and educational level. We first of all found that increased same migrant-origin presence in the neighbourhood had protective effects on tobacco-related cancer mortality for men in most groups. Second, only Turkish men had a mortality disadvantage when Turkish concentration was higher. Third, effects were not detected across all indicators of same-origin presence, nor among most groups of women. Finally, for several groups, neighbourhood effects were mediated by generational status and educational level.     

The pro of entry to the medical course in Belgium

Belgium already has a very high ratio of doctors to population. The output of new graduates is higher than can be justified by employment prospects. Applicants to university must be admitted if they have passed the school 'maturity examination'. The standard of this is set by the individual school, and the pass rate is unrelated to university requirements. Consequently the rate of entry to medical studies is very high and there is a very high failure rate (nearly half). The climate of opinion is against radical reform of this system. The author believes that under present circumstances a strongly selective examination at the end of the first university year is the least unsatisfactory solution.     

Infant mortality in the Flemish Region of Belgium 1999-2008: a time-to-event analysis

Background

When calculating life expectancy, it is usually assumed that deaths are uniformly distributed within each of the age intervals. As most of the infant deaths are neonatal deaths, this calls for a better assessment for that age group.

Methods

The Flemish unified death and birth certificates database for all calendar years between 1999 and 2008 was used. A Kaplan-Meier survival analysis on a yearly basis was performed to assess the mean time-to-event and to compare survival curves between both genders.

Results

Over the last years, a slight though not steady decrease of the infant mortality rate is observed. In 2008, the probability among live births of dying before their first anniversary is 4.6‰ in boys and 3.5‰ in girls. The large majority (about 85%) of these have died in their year of birth. The mean survival time of deaths in their year of birth was found to centre around 1 month (about 30 days), which results in a ''mean proportion of the calendar year lived'' (k1) close to 0.09. Among those who died in the year after their year of birth yet before their first anniversary, no such concentration in time of the deaths is observed. Differences between the gender groups are small and generally not statistically significant.

Conclusion

Statistics Belgium, the federal statistics office, imputes a value for k1 equal to 0.1 for infant deaths in their year of birth when calculating life expectancy. Our data fully support this value. We think such refinement is generally feasible in calculating life expectancy.     

我国三级妇幼医院住院患者护理服务满意度及影响因素分析

目的调查我国三级妇幼医院住院患者对护理服务的满意度现状并探讨其影响因素,为护理服务质量持续改进提供参考。 方法依托第5次“全国改善医疗服务行动第三方评估”项目,采用问卷对全国33家三级妇幼医院住院患者进行调查。应用SPSS 26.0软件对数据进行统计学分析。结果5 969名妇幼医院住院患者对护理服务总满意度为94.15%,各维度满意度从高到低依次为人文关怀、专业技能、仪容仪表、健康指导、环境设施。医院分布地区、患者就诊科室、年龄、家庭年收入是妇幼医院住院患者护理服务满意度影响因素。结论我国三级妇幼医院住院患者对护理服务满意度总体较高,但在健康指导、环境设施方面仍有待改善。在政策制定方面,应关注区域间及区域内护理资源配置的公平性;在医院管理方面,应重视妇产科住院患者的需求及妇产科护士工作积极性的调动;在医院满意度评价中,应关注患者社会人口学特征的影响,使患者对护理服务建立合理预期等。     

Hospital financing in Belgium: recent changes and future options.

A new mode of financing hospital operating costs has been gradually introduced in Belgium since 1982. It is a 'prospective pricing' system. Each hospital is assigned a budget envelope at the beginning of the fiscal year. This budget is calculated on a per diem basis. A portion of the budget is variable in function of the number of patient days. The annual budget of each hospital is determined by comparing its performance with the one of a reference group of similar hospitals. Since the introduction of the new mode of financing the financial situation of the Belgian hospitals has improved markedly. Moreover, the hospital expenditures of the health insurance scheme are under control: in 1984 and 1985 these expenditures increased at a lower rate than inflation. The continued increase of other medical expenditures, however, indicates that the principles of this new financing system should be extended to the medico-technical departments.